Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | 0131-001627 | VA |
Y | 225X00000X | Occupational Therapist | 0119008502 | VA |
NPI | 1013457282 |
---|---|
Provider Name | Samantha Maley |
First Address | Virginia Beach, VA 23462-5631 |
Second Address | Virginia Beach, VA 23462-5631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2017 |
Last Update Date | 08/09/2020 |